“镇痛鸡尾酒”局部浸润在腰椎后路融合术术后镇痛中的疗效观察  

Clinical outcome of local infiltration with "cocktail analgesics" for pain management after posterior lumbar intervertebral fusion

作　　者：刘颖[1] 赵军[1] 丁浩洋 陈举 文化[1] LIU Ying;ZHAO Jun;DING Hao-yang;CHEN Ju;WEN Hua(Department of Spinal Surgery,Chongqing Orthopaedic Hospital of Traditional Chinese Medicine,Chongqing 400012,China)

机构地区：[1]重庆市中医骨科医院脊柱外科,重庆400012

出　　处：《颈腰痛杂志》2022年第6期785-789,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的 探讨罗哌卡因复合甲泼尼龙、右美托咪定和肾上腺素局部应用于单节段腰椎后路融合术的有效性和安全性。方法 纳入2018年3月~2019年1月拟行单节段腰后路减压、椎间植骨融合、椎弓根螺钉内固定术(posterior lumbar intervertebral fusion, PLIF)的80例腰椎退行性疾病患者,随机分为鸡尾酒组和对照组各40例。鸡尾酒组手术结束后用“镇痛鸡尾酒”溶液在切口两侧逐层浸润,对照组在手术结束后用生理盐水在切口两侧逐层浸润,术后均常规使用静脉自控镇痛(patient-controlled intravenous analgesia, PCIA)泵。记录患者术前及术后2 h、4 h、6 h、12 h、24 h及48 h的疼痛VAS评分,术后首次追加镇痛的时间、PCIA泵有效按压次数、PCIA泵曲马多用量、术后曲马多肌内注射用量、术后曲马多总用量、术后下床时间、术后腰背肌开始锻炼时间、术后住院时间、不良反应发生情况及患者满意度,并进行统计学分析。结果 鸡尾酒组术后24 h内各时间点VAS评分均显著低于对照组(P<0.05),但两组术后48 h时VAS评分无统计学差异(P>0.05);鸡尾酒组术后首次追加镇痛的时间显著晚于对照组(P<0.05);PCIA泵有效按压次数、PCIA泵曲马多用量、术后曲马多肌内注射用量及术后曲马多总用量方面,鸡尾酒组的数据均显著低于对照组(P<0.05);鸡尾酒组术后下床时间及腰背肌开始锻炼时间均显著早于对照组(P<0.05);鸡尾酒组术后平均住院时间显著少于对照组(P<0.05)。对照组术后14例出现恶心呕吐症状,鸡尾酒组出现4例,差异有统计学意义(P<0.05),两组其他不良反应发生情况无统计学差异(P>0.05)。鸡尾酒组术后满意度显著优于对照组(P<0.05)。结论 罗哌卡因复合甲泼尼龙、右美托咪定及肾上腺素局部浸润镇痛方案,对单节段PLIF术后早期疼痛控制效果良好,可显著减少术后曲马多用量,降低术后恶心呕吐发生率,促进早期下床和功�Objective To assess the efficacy and safety of ropivacaine combined with methylprednisolone, dexmedetomidine and epinephrine for local application in single-segment posterior lumbar intervertebral fusion(PLIF). Methods From March 2018 to January 2019, 80 lumbar degenerative diseases patients undergoing single-segment PLIF were randomly divided into the cocktail group(n=40) and the control group(n=40). Before incision closure, the patients in the cocktail group were infiltrated with "cocktail analgesic" on both sides of the incision, and the patients in the control group were infiltrated with normal saline on both sides of the incision, then all patients were routinely used patient-controlled intravenous analgesia(PCIA) pump after operation. The VAS scores of 2 h, 4 h, 6 h, 12 h, 24 h, 48 h after operation and preoperative VAS score, the postoperative time to first analgesic request, the total times of pressing PCIA pump, the consumption of PCIA tramadol, the postoperative consumption of intramuscular injection(I.M.) tramadol, the postoperative total consumption of tramadol, the postoperative off-bed time, the postoperative time to start exercise lumbar dorsal muscle, the postoperative hospital stay, the postoperative adverse reactions and the patients’ satisfaction were recorded and analyzed. Results The VAS score of cocktail group was significantly lower than that control group at all time points within 24 h after operation(P<0.05), but there was no significant difference between the two groups at 48 h after operation(P>0.05). The postoperative time to first analgesic request of cocktail group was significantly later than that of control group(P<0.05). The total times of pressing PCIA pump, the consumption of PCIA tramadol, the postoperative consumption of I.M. tramadol, the postoperative total consumption of tramadol of cocktail group were significantly lower than those of control group(P<0.05). The postoperative time to start exercise lumbar dorsal muscle of cocktail group was significantly earlier than that

关 键 词：镇痛鸡尾酒 腰椎后路融合手术 术后疼痛 局部浸润镇痛 快速康复 

分 类 号：R614.32[医药卫生—麻醉学]